Indiana has improved its Medical Liability Environment and Access to Emergency Care grades but still faces numerous challenges, including a need for state-level planning and coordination to improve the Quality and Patient Safety Environment, as well as Disaster Preparedness.
Indiana's Medical Liability Environment improved somewhat since 2009 and now boasts the second lowest average malpractice award payment in the nation ($122,334). The state has implemented many important reforms that contribute to this low rate, including apology inadmissibility laws, mandatory pretrial screening panels, rules that require malpractice awards to be offset by collateral sources, and a medical liability cap on total damages. Indiana also has a patient compensation fund in place to help cover monetary awards in medical malpractice cases. Indiana providers enjoy lower-than-average medical liability insurance premiums for primary care physicians ($10,154) and specialists ($49,113).
Although Indiana faces significant workforce challenges with low per capita rates of neurosurgeons; orthopedists and hand surgeons; plastic surgeons; and ear, nose, and throat specialists, the state has some strengths in Access to Emergency Care. The state has a relatively adequate number of medical facilities, with a very low hospital occupancy rate (60.6 per 100 staffed beds) and better-than-average emergency department wait times (239 minutes), staffed inpatient beds (313.3 per 100,000 people), and psychiatric care beds (24.6 per 100,000). Indiana has some of the lowest rates of adults and children with no health insurance (14.2 and 5.6%, respectively). It has an unfortunately low Medicaid fee level for office visits, at 66.1% of the national average, though this represents a 16.8% fee level increase since 2007.
Indiana faces many challenges in Disaster Preparedness due to lack of written procedures for emergency response coordination and a fractured emergency response system. The state does not have an Emergency Support Function 8 (ESF-8) or all-hazards plan. Although Indiana has a statewide medical communication system and a statewide just-in-time training system, other statewide planning and coordination efforts are lacking, including statewide patient tracking and real-time syndromic surveillance systems. In terms of infrastructure, however, Indiana has a high per capita rate of intensive care unit beds and verified burn centers, although the state's bed surge capacity is quite low.
Indiana's Quality and Patient Safety Environment grade has declined, largely because of its failure to implement policies at a pace consistent with the rest of the nation. For instance, Indiana is one of few states that have not begun developing a stroke or a ST-elevation myocardial infarction (STEMI) system of care. The state also lacks destination policies for stroke and STEMI patients.
Indiana continues to face challenges related to Public Health and Injury Prevention, particularly in the area of child and infant health. For instance, the state has a relatively low percentage of young children who have received recommended immunizations (73.4%) and one of the higher infant mortality rates in the nation (7.6 per 1,000 live births). It also has a relatively high infant mortality disparity ratio, with non-Hispanic Black infants being 2.8 times more likely to die in the first year than the racial and ethnic group with the lowest infant mortality rate.
Indiana must address the severe shortage of specialists to improve care for its people. The positive changes to the Medical Liability Environment that have resulted in low insurance premiums are a good start toward recruiting and retaining more providers; however, a concerted effort is needed to significantly increase the number of providers available and willing to be on call in the emergency department.
Indiana's Disaster Preparedness planning is in need of substantial improvement, starting with improved coordination between the various agencies responsible for emergency response and involvement of the state's public health and emergency physicians in emergency response planning. Improving the state's medical response plans and implementing more training opportunities should follow from these first steps.
Indiana should work to improve its Quality and Patient Safety Environment by developing policies and procedures that ensure that patients get the care they need. A uniform system for providing pre-arrival instructions and destination policies for stroke and STEMI patients would go a long way toward improving the state's emergency medical system of care. The Indiana House of Representatives has established a taskforce to examine the need for and establishment of a state EMS physician medical director to improve the quality of services delivered. The findings of this taskforce must be thoughtfully considered, as it represents a potentially promising step toward improving the system of care.